MONTENEGRO
MINISTRY OF HEALTH
OVERVIEW OF THE MONTENEGRIN
HEALTH SYSTEM
Nina Milović
Secretary of the Ministry of Health of Montenegro
University Donja Gorica, 15-16 February 2017
Introduction
MONTENEGRO
MINISTRY OF HEALTH
Size of the country: 13,812 km2
Population size: 620 029 (Census 2011th),
622 099 (Estimates of population January 2015th
MONSTAT)
Life expectancy: men 71.7; women 76.1
(2009 MONSTAT)
Child mortality: 5.6 (The mortality rate of
children under five years in the 2012)
Health expenditure as GDP %: 9.12
GDP per capita: 5063 (2012)
Share of the sector Q (Health and social
care) as GDP %: 3.9 (2012)
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Regions
MONTENEGRO
MINISTRY OF HEALTH
Northern ‐ mountain region
Central region
Southern‐- sea region
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Organization of health care services
MONTENEGRO
MINISTRY OF HEALTH
Tertiary
Secondary
Primary
The organization of health
care services in Montenegro
is similar like in most
European countries. Health
care is provided at the
primary, secondary and
tertiary level
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MONTENEGRO
MINISTRY OF HEALTH
Network of Public
Health Institutions
Pljevlja
Clinical center (1)
Žabljak
Plužine
General hospital (7)
Mojkovac
Šavnik
Bijelo Polje
Rožaje
Berane
Special hospital (3)
Nikšić
Kolašin
Andrijevica
Health center (18)
Kotor
PODGORICA
Herceg Novi
•
•
•
•
Institute for Public Health
Public pharmacies
Montefarm (55)
Institute for health
emergency
Institute for blood
transfusion
Tivat
Plav
Danilovgra
d
Cetinje
Budva
Bar
Ulcinj
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Human resources
MONTENEGRO
MINISTRY OF HEALTH
▪ There are approximately 8000 employees in the public health
institutions.
▪ About 77% of total number of employees is health care workers, while
23% are non-medical staff.
▪ Carriers of health care in the health system are doctors and nurses, and
indicated number of doctors per number of citizens is important for the
assessment of health care in the certain country.
▪ The indicator for Montenegro is 216 doctors per 100000 inhabitants,
and is lower than the indicator in the EU (334 in 2011, according to
WHO data and nurses….).
▪ The public health care system in Montenegro employs 1397 doctors and
dentists, of whom 1370 doctors and 27 dentists.
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Capacities
MONTENEGRO
MINISTRY OF HEALTH
▪ 2466 beds
▪
▪
▪
▪
1110
96
504
756
general hospitals
stationary DZ
stand.beds in SH
stand.beds in KCCG
▪ CG: 3,92 beds / 1000
▪ EU: 5,29 beds/ 1000
(Source: WHO-HFA-DB, 2008.)
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Legal and strategic framework
MONTENEGRO
MINISTRY OF HEALTH
▪ Law on Health protection
▪ Law on Health insurance
▪ Decision on Health Institution Network
▪ Strategy on the optimisation of secondary and tertiary
health care level with Action plan for implementation
▪ Master plan for health development in Montenegro
2015-2020
# Based on EU documents and Health 2020 strategy
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Model of Financing
MONTENEGRO
MINISTRY OF HEALTH
▪ The system of financing has the characteristics of the
Bismarck model, which as a form of health care financing
that implies contributions as the main source of income,
with its strict purpose for covering health care and health
insurance rights .
▪ The health care system is based on the principles of
compulsory health insurance, so that all Montenegrin
citizens are covered by health insurance (about 620,000
insured and around 14000 refugees, uninsured persons,
asylum seekers and other categories)
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MONTENEGRO
MINISTRY OF HEALTH
▪ Health insured persons in Montenegro,
exercise their health care rights in public
health institutions, as well as other health
institutions with which Health insurance Fund
has concluded a contract on providing health
care services abroad.
▪ From 2008, dental health care is organized
outside the public health care, and it is
performed within private dental institutions.
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Functional scheme of health insurance
MONTENEGRO
MINISTRY OF HEALTH
Collection of
contributions
Insured
persons
Providing
health care
services
Providing the health insurance, management,
organization
Tax
administration
TREASURY
(Ministry of Finance)
Contributions
payment
Providers of
health care
services
HIF
Health
Insurance
Fund
Contractual
relations and the
Accounting
regimes
- Primary
- Secondary
- Tertiary
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MONTENEGRO
MINISTRY OF HEALTH
Economic indicators of
health care funding
• Total expenditures in Montenegro in 2014 were 6.7% of gross
domestic product, of which public expenditure on health
represents 5.3% of GDP while private spending on health care
accounts for 1.5% of GDP.
• Compared with the average expenditure on health at EU level,
Montenegro expenditure during 2012 was lower by 1.1 percentage
point.
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Budget 2016
MONTENEGRO
MINISTRY OF HEALTH
Total: 181.532.009,81 €
▪ 292,78 € / per capita
▪ More for this year 10.441.789,43 € then for 2015
▪ Budget for health is 8,54% from total budget of Montenegro
for 2016
▪ About 6,10 % higher health budget for 2016 compared to
2015
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MONTENEGRO
MINISTRY OF HEALTH
Main challenges
- priority for solving
▪ Established right financial opportunities??
▪ A large share of private funds
▪ Insufficient availability
▪ STRUCTURE health workers
▪ 100 MED. – 32 NonMED.
▪ 2,06 / 1000 inhabitants /number of doctors
▪ 3,4 / 1000 inhabitants / Europa
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Leading causes of morbidity
MONTENEGRO
MINISTRY OF HEALTH
▪ Chronic non-communicable diseases: the leading common diseases,
disability and premature (before age 65) dying residents of
Montenegro
▪ nearly 2/3 of the total burden of disease
 Ischemic heart disease,
 cerebrovascular disease,
 lung cancer,
 affective disorders (unipolar depression) and
 Diabetes mellitus (diabetes)
 malignant neoplasms - 8.7% of all cases of hospital discharge, the
fourth most common reason for hospitalization in 2006.
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MONTENEGRO
MINISTRY OF HEALTH
Areas for reform intervention
1) Resources (human resources, IT,
pharmaceuticals)
2) Providing services (network and integration,
package, quality, application technology)
3) Financing of the health care system (services,
not capacity per event)
4) Management
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Integrated information system
MONTENEGRO
MINISTRY OF HEALTH
Safe and efficient exchange of information between all stakeholders of the health system is a requirement for the
information system functionalities. The introduction of electronic services (e-health) at all levels can contribute
significantly health care functional improvement of the system, and consequently leads to improvements in the
quality, continuity and availability of health care - e-prescription, e-scheduling, e-referral, e-prescribing guidelines, e –
clinical guidelines, e-reimbursement list, e-forms. IT allows tracking of all the costs in the health system - referral of
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patients, diagnosis, prescriptions, sick leaves etc
Reform - reasons
MONTENEGRO
MINISTRY OF HEALTH
Main challenges in Health system of Montenegro:
1. Lack of coordination and integration
2. The focus on providing curative care to patients, and much less
towards preventive work to the total population
3. The gap between established rights in health insurance and the
financial means to meet the unrealistic expectations of citizens and
employees in the health care system
4. Inadequate method of allocating resources to priorities and levels of
health care
5. Inadequate payment method for health services and unclear
methods of financing health institutions
6. Health care is not programmed according to the needs, priorities and
specific needs, particularly local level
7. A large number of non-medical employees and inadequate
composition of health workers
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Reform – reasons-cont.
MONTENEGRO
MINISTRY OF HEALTH
▪ Lack of a national medicine policy and the irrational use of medicines
▪ Health Management does not fit the modern concept of the health
system, in particular the planning system
▪ Records and reporting system, poor quality and unresponsive
▪ No level of the health system does not perform control of the scope
and quality of registered data
▪ Underdeveloped the control system and improving the quality of
health care
▪ Lack of motivation to provide quality services, and health care
workers are underpaid
▪ There is an apparent stagnation of population health, parallel to the
floor of the social and living standards
▪ The existence of informal payments / corruption
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MONTENEGRO
MINISTRY OF HEALTH
Key health sustainability challenges of 21st
century in Montenegro
▪ Demographic transition: aging population
▪ Epidemiological transition: NCDs epidemic
▪ premature mortality (25% before the age of 60)
▪ Financial pressure
▪ Health impact of global warming and climate change:
interdependence of health sustainability and environmental sustainability
▪ National strategy on adaptation of health system to climate change
▪ Social and economic disparities resulting in increased health inequalities
▪ Health system re-orientation and financing:
▪ Further PHC strengthening
▪ Shift from acute care to prevention
▪ Integrated service delivery across health care levels , including integration
of preventive programs at PHC to respond effectively to chronic conditions
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Health 2020 a way towards sustainability
MONTENEGRO
MINISTRY OF HEALTH
Working to improve health
for all and reducing
the health divide
Improving leadership, and
participatory governance
for health
Health 2020: four common policy priorities for health:
Investing in
health through
a life-course
approach and
empowering
people
Tackling
Europe’s major
health
challenges:
NCDs and
communicable
diseases
Strengthening
people-centred
health systems,
public health
capacities and
emergency
preparedness,
surveillance
and response
Creating
resilient
communities
and supportive
environments
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Main Lessons
MONTENEGRO
MINISTRY OF HEALTH
Requirements for operationalization of synergy inspired by
Health 2020:
• Innovative thinking;
• Dynamic and new governance and leadership (participatory
approaches (this could give a voice and empowerment to the
community in tourism planning and activity development)
• Building the capacity of the health authorities up to the new roles
in shaping smart policies to promote health and wellbeing
• Further health system strengthening (to bring the quality health
services closer to the citizens /tourists with special focus on
promotion and health prevention services)
• Ensure a sufficient number and proper mix and distribution of
health care workers with adequate skills and competences
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PRIORITIES
MONTENEGRO
MINISTRY OF HEALTH
▪ Education
▪ Prevention programs
▪ The new model of financing secondary and tertiary
health care
▪ Pharmaceutical policy
▪ The introduction of DDO (supplementary and additional
voluntary health insurance)
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MONTENEGRO
MINISTRY OF HEALTH
Thank You!
Nina Milović
Secretary of the Ministry of Health of Montenegro
University Donja Gorica, Wednesday, 15th February 2017